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所在平台: Coursera |
课程主页: https://www.coursera.org/learn/fixing-healthcare-delivery-advanced-lean
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课程名称：修复医疗交付 2.0：高级精益 课程概述：精益生产或丰田生产系统（TPS）曾在汽车工业中引发革命，为汽车和卡车制造提供了高可靠性和安全性。本课程旨在帮助医疗提供者、管理者、工程师及医疗专业学生学习如何将精益原则和工具应用到医疗领域。学生将了解如何识别和消除浪费，设计标准化工作，应用5S，绘制价值流图，创建流程图，开展快速改进活动，平衡流程，使用A3表格和帕累托图，应用防错和创建有效的视觉控制。课程通过减少技术性语言，结合患者案例来增强课程的吸引力。我们特别调整了精益理念，以适应医疗行业，并称之为以患者为中心的医疗交付系统（PHDS），强调两个关键原则：1. 持续应用科学方法以改进护理系统；2. 所有改进应从患者的角度出发。掌握这些新知识后，学生将能够设计和实施可持续的医疗交付系统改进。 课程大纲： 第一部分：介绍将TPS或精益应用于医疗 讨论TPS的四个原则及其如何在医疗中转化，进而改善患者护理质量。 第二部分：减少浪费 介绍医疗中的8种浪费及其识别与消除方法，强调5S工具的应用，以提高效率，减少诊断测试的过度使用。 第三部分：标准化工作与价值流映射准备 讨论标准化工作的必要性及如何设计标准化工作，介绍时间观察表等工具。 第四部分：价值流与流程映射、RIE和流量平衡 讲解如何进行价值流映射，识别和消除工作流程中的瓶颈和浪费，并提出流程平衡的原则。 第五部分：防错与视觉控制 探讨医源性错误的预防，介绍不同的错误报告方式和Just Culture文化，并提供有效的错误预防工具，如帕累托图和故障模式及效应分析（FMEA）。总结课程中的主要内容，强调以患者为中心的医疗交付系统（PHDS）的重要性。
Part: 1
Title:Introduction to Applying TPS or Lean to Healthcare
Description:Toyota Production System (TPS) or Lean has allowed Toyota to become the number one automobile manufacturer in the world by progressively improving the quality and reliability of their products. The System of Profound Knowledge developed by the American, W. Edward Deming is the basis for TPS or Lean. This system has now been adapted to healthcare by Virginia Mason Medical Center and Denver Health with exciting results. You will be introduced to the 4 principles of TPS, as well as the TPS House that illustrates how the various tools of TPS fit together to continually add value to the care of patients. The challenges faced by both health systems will be discussed and their approaches to transforming their delivery systems described. When Lean is applied to healthcare, patient care improves, and both patient mortality and the cost of care decrease. Applying Lean to healthcare systems can revolutionize how healthcare is delivered.
Part: 2
Title:Waste Reduction
Description:Waste is a huge problem in modern health care. It has been estimated that 30-60% of all that we do is wasteful and is not of value. Lean has categorized 8 forms of waste allowing everyone on the front lines to recognize waste and work to remove it. 5S is a very helpful tool that can be used early in the implementation of lean and can remove clutter and quickly improve efficiency. A major form of waste is the excessive use of diagnostic tests, as well as delayed or missed diagnosis. In this session you will be introduced to the 8 forms of waste, the use of 5S, how illness scripts can be used to create a tiered diagnostic list, and how Bayes Theorem can be used to select the highest yield tests. Using this approach diagnosticians can more quickly and cost effectively arrive at diagnoses. Waste is the foundation of Lean and by removing waste we can progressively increase the value of patient care.
Part: 3
Title:Standardized Work and Preparing for Value Stream Mapping
Description:Standardized work is an absolute necessity for improvement. Without standardized work there can be no improvement. This is one of the most difficult concepts to relay to those on the front lines particularly physicians, who call this "cookbook medicine". In this module the philosophy behind creating standardized work is reviewed, and the importance of everyone on the front line participating in creating and continually modifying standardized work emphasized. You will be introduced to tools that will help you to effectively design standardized work: the spaghetti diagram and the Time Observation Sheet. Lead Time, Cycle Time and Takt Time will be defined. You will learn how time the individual steps of a work process. You will also learn how to use a percentage load chart to calculate how many workers are required to meet production demand.
Part: 4
Title:Value Stream & Process Mapping, RIEs, and Leveling Flow
Description:Value stream mapping is at the heart of TPS or Lean. Using the Time Observation Sheets you will learn how to fill out a Value Stream Map, including determining WIP (work in progress) depicting physical movement and process flow along with information flow, and assessing when work is value-added and when it is non-value added. Value stream maps are used to identify bottlenecks and wasteful steps in a work process and then process mapping and rapid improvement events (RIEs) can be used to remove these wasteful processes and impediments to workflow. Finally you will be introduced to the principles of leveling both under elective and emergency treatment conditions. Applying these tools can dramatically improve efficiency and productivity without increasing overall manpower.
Part: 5
Title:Error Proofing and Visual Controls
Description:Preventable medical errors are estimated to kill 100,000 to 440,000 people per year in the U.S. and similar levels of harm due to medical errors have also been observed in other countries. In order to effectively eliminate errors, we must first be able to recognize and report them and different types of error reporting are described. Secondly there must be a culture in place that deals fairly with errors by differentiating systems errors from individual human errors. This can be accomplished by applying a Just Culture. Additional tools for eliminating errors and improving processes are introduced including: the Pareto Chart, Failure Mode and Effects Analysis (FMEA), an expanded Plan, Do, Study, Adjust cycle, and the A3 form. There are 6 levels of error proofing and their effectiveness in preventing errors from reaching patients is assessed using clinical examples. Visual controls can be helpful for reducing errors and for following the progress of work process improvements. In the final video the major topics covered in this course are summarized, and a new name for TPS or Lean adapted to healthcare is proposed: Patient-centered Healthcare Delivery System (PHDS). This name emphasizes the importance of applying the scientific method, like PhDs, to continually improve healthcare delivery while always focusing on the needs of patients.
Lean or Toyota Production System (TPS) is responsible for revolutionizing the auto industry by creating highly reliable and safe cars and trucks. In this course healthcare providers, administrators, engineers, and healthcare professional students will be taught how to apply the principles and tools of Lean to health care. They will learn how to identify and remove of waste, design standardized work, apply 5S, map Value streams, create process maps, conduct rapid improvement events (RIEs), level workflow, use A3 forms and Paredo charts, apply error proofing, and create effective visual controls. The instructional videos minimize Lean technical language, and include patient cases to make the lessons more appealing to students in healthcare. Acknowledging that patients are very different from cars we have carefully adapted Lean to health care and call our system: Patient-centered Healthcare Delivery System (PHDS). The name and abbreviation emphasize two key principles taught in our course: 1. Just like PhDs the scientific method must be continually applied when creating plans to improve our systems of care. 2. All improvements must be made looking through the eyes of patients. Armed with this new knowledge students will be able to design and implement sustainable healthcare delivery system improvements.
